Most people go through years of struggle with acne. While some adults wrestle with the problem into middle age, acne leaves nearly everyone past the age of 20 at least a few little reminders that it was there: acne scars.
Acne scars are remarkably varied, and some people escape adolescence with only a negligible number. Others aren’t as lucky. Adults whose acne scarring is severe enough to be immediately apparent can take heart: several approaches, ranging from homespun remedies to advanced surgical methods, can greatly reduce the appearance of acne scars, restoring patients’ confidence along with their skin.
What Exactly Are Acne Scars?
Different kinds of acne tend to leave different kinds of scars. Patients who hope to eliminate their acne scars should acquaint themselves with their variety before pursuing a plan of action.
Acne forms when the skin’s oils combine with dirt and dead skin cells to block pores. As most of us know from experience, acne presents itself in different forms. Each of these tends to leave behind different types of scars, but two types of severe acne are the worst culprits.
Pustular acne presents itself as broad areas of inflammation surrounding raised, pus-filled bumps. In other words, pimples.
Cystic acne spreads more widely than pustular acne, and does not rise as prominently above the skin’s surface. Instead, cystic acne grows under the skin’s surface, creating large, red, painful blotches.
As acne progresses, its associated inflammation can worsen, and lesions can form. This is especially true of pimples that have been squeezed: the temptation is understandable, but squeezing pimples tends only to exacerbate the problem.
When acne lesions form, the body responds by sending new collagen to the site. Collagen, the body’s most abundant protein, is a fibrous, elastic material that gives the skin its firmness and contributes greatly to its shape. When new collagen is sent to compensate for the damage done by acne lesions, it changes the skin’s depth and texture, resulting in the elevations or depressions we know as acne scars. The exact nature of a given acne scar is determined largely by the way a patient’s skin allocates collagen.
What Kinds of Acne Scars Are There?
Elevated, or hypertrophic, scars appear as small lumps created when the body creates too much collagen as it heals from an acne attack. Since these lumps are made largely of collagen, they may feel a bit firmer than the surrounding tissue.
Sunken, or atrophic, scars appear as depressions in the skin. They are created when the tissue beneath an acne blemish becomes so damaged that it is unable to produce enough new collagen to compensate for the volume lost to acne. Because they owe so much to the nature of the original pustule or cyst, and because surrounding skin may have contributed a bit of collagen toward a partial closing of the original wound, atrophic scars appear in a variety of forms. The three most common are:
- Rolling scars: large, rounded depressions with sloping edges
- Boxcar scars: deep depressions with steep edges
- Icepick scars: very deep, V-shaped depressions.
Are Acne Marks the Same as Acne Scars?
No, acne marks are different than acne scars. When a pimple heals, it sometimes leaves behind dark-red or brown spots; these are acne marks.
Acne marks are temporary cases of hyperpigmentation, and do not involve structural change to the skin, as do acne scars. They typically linger for two months or so before fading away, and in most cases eventually disappear altogether.
How Can Acne Scars Be Prevented?
The best way to avoid acne scars is to treat acne as soon as it develops. The more serious a case of acne, the likelier it is to cause scarring. In most cases, mild cases of acne can be treated early on by over-the-counter products. If acne becomes severe, it may be wise to consult a dermatologist; even in advanced cases, a doctor may be able to suggest treatments and methods that reduce the chances of scarring.
How to Find the Right Dermatologist
Many doctors are qualified to diagnose and treat acne scars. Since the problem is so common, acne-scar treatment is offered by a wide range of experts…and by people calling themselves experts. Patients should research prospective doctors carefully, paying close attention to each physician’s credentials and years of experience, and making note of the range of treatments offered by each. An experienced doctor with proper certifications, offering a wide range of treatment options, is the safest bet.
Can Acne Scars be Permanently Removed?
It’s not quite that simple. On the one hand, acne scars are at least somewhat permanent: even the most successful treatment cannot promise to remove every molecule of excess collagen causing a raised acne scar, and when tissue is lost to atrophic scarring, it can never be completely restored.
But the visible effects of acne scars can be greatly reduced. When acne-scar treatment is administered by experienced doctors, patients report average improvement of 60% to 80%, which represents a dramatic improvement, if not a complete erasure of acne scarring. Factors affecting the success of acne-scar treatment include the severity and nature of the scars themselves, the character and innate healing ability of the patient’s skin, and external factors such as smoking (which tends to inhibit skin’s healing ability).
What Methods Are Most Effective at Reducing the Appearance of Acne Scars?
Acne has been with us forever, and so has acne scarring. Over the years, people have developed home remedies that claim to be at least modestly effective at treating acne scars. More recently, skincare products offer similar promises, at a bit more cost than home remedies and with slightly more provable results. At the advanced end of the spectrum, several surgical options have been developed to more completely combat acne scars, some of them non-invasive.
Home remedies are highly safe, and often rely on natural ingredients. While they may not do much to diminish existing acne scars, they can be somewhat effective against acne itself. As a preventive measure against scarring, they may not help very much, but they certainly can’t hurt.
The most popular home treatments for acne tend to be face masks. Papaya face masks, for instance, contain enzymes that dissolve dead skin cells, which are then washed away. This alleviates one of the major causes of acne itself, and may well help keep minor outbreaks from growing severe and leaving scars. Face masks tend not to be backed by clinical trials, and little actual proof exists that they are significantly effective.
Medicated skincare products, including alpha hydroxy acids, have become popular weapons against acne. While they have been proven to limit the severity of acne outbreaks, their effectiveness against existing acne scars is less verifiable. Alpha hydroxy acids are essentially exfoliants, which remove the top layer of skin, clearing out dead skin cells and encouraging healthy new tissue to grow. They may be effective at limiting the depth of some acne scars, and the new layers of skin that grow after treatment may diminish the diameter of acne scars.
Advanced treatments for acne scars include topical, noninvasive, and invasive procedures.
Chemical peels work much the same as the exfoliants found in medicated skincare products, but tend to be more aggressive. Using an acidic compound to burn away the top layers of skin, chemical peels provide the same diminishment of acne scars’ depth as other exfoliative treatments, and tend to be much more effective against pigmentation issues associated with acne.
As the name suggests, microneedling works by creating tiny punctures in the skin. This damages the collagen underlying acne scars and breaks up unsightly concentrations of collagen. It also encourages the production of new collagen, only more smoothly and over a larger area than the tissue created in response to the original acne attack.
Fractional laser treatment uses a finely tuned laser, divided into scores of tiny beams, to disrupt the collagen underlying acne scars. In this sense, it functions much like microneedling. The major difference is that fractional lasers do not penetrate the skin; instead, they focus their energy specifically on the collagen layer. Laser skin treatment may result in some swelling immediately after each session, but this clears up quickly. Some doctors believe that laser skin treatment combined with microneedling promotes greater collagen production.
Dermal fillers are biocompatible compounds injected directly into areas in need of extra volume. This method is effective at reducing the depth of stubborn acne scars, and some fillers include collagen-promoting components. When used to reduce acne scars, the procedure initially causes some redness and swelling, which disappear quickly. Results are immediate, and typically last for 6 months to a year.
How Much Does Acne-Scar Treatment Cost?
Depending on the treatment chosen, the extent of the problem, and the experience and qualifications of the presiding physician, advanced acne-scar treatments can cost as little as $1,200 or more than $5,000.
Above all, patients seeking to reduce the appearance of their acne scars should start with a full, frank consultation with a carefully chosen doctor. With some knowledge of the problem and a realistic idea of which treatments can yield what kinds of results, most people can achieve dramatic, even life-changing improvements to their face’s tone and texture.